Effect of hydrogen on cell pyroptosis during lung injury in severely burned rats / 中华麻醉学杂志

Objective:To evaluate the effect of hydrogen on cell pyroptosis during lung injury in severely burned rats.Methods:Forty-eight clean-grade healthy adult male Sprague-Dawley rats, weighing 200-230 g, aged 6-7 weeks, were divided into 4 groups ( n=12 each) by the random number table method: sham operation group (SH group), sham operation+ hydrogen group (SH+ H 2 group), burn group (B group) and burn+ hydrogen group (B+ H 2 group). In group B and group B+ H 2, the Ⅲ degree burn model of the back (about 40% of the total body surface area) was prepared in anesthetized animals. The back was shaved and then subjected to a perm at skin temperature in group SH and group SH+ H 2. Rats were exposed to 2% hydrogen for 1 h starting from 1 and 6 h after burn in SH+ H 2 group and B+ H 2 group, respectively. At 12 and 24 h after burn, the rats were sacrificed and lung tissues were obtained for examination of pathological changes which were scored and for determination of the contents of interleukin-1beta (IL-1β) and IL-18 in lung tissues (by enzyme-linked immunosorbent assay) and expression of NOD-like receptor thermal protein domain associated protein 3 (NLRP3), caspase-1 and Gasdermin D protein (GSDMD) in lung tissues (by Western blot). Results:Compared with SH group, the pathological scores were significantly increased at 12 and 24 h after burn in group B ( P<0.05). The pathological scores were significantly decreased at 12 and 24 h after burn in group B+ H 2 as compared with group B ( P<0.05). Compared with SH group, the contents of IL-1β and IL-18 in lung tissues were significantly increased at 12 and 24 h after burn, and the expression of NLRP3, caspase-1 and GSDMD was up-regulated in B and B+ H 2 groups ( P<0.05). Compared with group B, the contents of IL-1β and IL-18 in lung tissues were significantly decreased at 12 and 24 h after burn, and the expression of NLRP3, caspase-1 and GSDMD was down-regulated in group B+ H 2 ( P<0.05). Conclusions:The mechanism by which hydrogen attenuates lung injury may be related to inhibition of cell pyroptosis in severely burned rats.

A markerless beam's eye view tumor tracking algorithm based on structure conversion and demons registration in medical image / 中华放射肿瘤学杂志

Objective:To propose a markerless beam's eye view (BEV) tumor tracking algorithm, which can be applied to megavolt (MV) images with poor image quality, multi-leaf collimator (MLC) occlusion and non-rigid deformation.Methods:Window template matching, image structure transformation and demons non-rigid registration method were used to solve the registration problem in MV images. The quality assurance (QA) plan was generated in the phantom and executed after manually setting the treatment offset on the accelerator, and 682 electronic portal imaging device (EPID) images in the treatment process were collected as fixed images. Meanwhile, the digitally reconstructured radiograph (DRR) images corresponding to the field angle in the planning system were collected as floating images to verify the accuracy of the algorithm. In addition, a total of 533 images were collected from 21 cases of lung tumor treatment data for tumor tracking study, providing quantitative results of tumor location changes during treatment. Image similarity was used for third-party verification of tracking results.Results:The algorithm could cope with different degrees (10%-80%) of image missing. In the phantom verification, 86.8% of the tracking errors were less than 3 mm, and 80% were less than 2 mm. Normalized mutual information (NMI) varied from 1.182±0.026 to 1.202±0.027 ( P<0.005) before and after registration and the change of Hausdorff distance (HD) was from 57.767±6.474 to 56.664±6.733 ( P<0.005). The case results were predominantly translational (-6.0 mm to 6.2 mm), but non-rigid deformation still existed. NMI varied from 1.216±0.031 to 1.225±0.031 ( P<0.005) before and after registration and the change of HD was from 46.384±7.698 to 45.691±8.089 ( P<0.005). Conclusions:The proposed algorithm can cope with different degrees of image missing and performs well in non-rigid registration with data missing images which can be applied in different radiotherapy technologies. It provides a reference idea for processing MV images with multi-modality, partial data and poor image quality.

Feasibility study of predicting lung tumor target movement based on body surface motion monitoring / 中华放射肿瘤学杂志

Objective:To evaluate the feasibility of predicting lung cancer target position by online optical surface motion monitoring.Methods:CT images obtained in different ways of stereotactic body radiotherapy (SBRT) plans from 16 lung cancer cases were selected for experimental simulation. The planned CT and the original target position were taken as the reference, and the 10 phases of CT in four dimension CT and each cone beam (CBCT) were taken as the floating objects, on which the floating target location was delineated. The binocular visual surface imaging method was used to obtain point cloud data of reference and floating image body surface, while the point cloud feature information was extracted for comparison. Based on the random forest algorithm, the feature information difference and the corresponding target area position difference were fitted, and an online prediction model of the target area position was constructed.Results:The model had a high prediction success rate for the target position. The variance explainded and root mean squared error ( RMSE) of left-right, superior-inferior, anterior-posterior directions were 99.76%, 99.25%, 99.58%, and 0.0447 mm, 0.0837 mm, 0.0616 mm, respectively. Conclusion:The online monitoring of lung SBRT target position proposed in this study is feasible, which can provide reference for online monitoring and verification of target position and dose evaluation in clinical radiotherapy.

A markerless beam′s eye view tumor tracking algorithm based on VoxelMorph-a learning-based unsupervised registration framework for images with missing data / 中华放射医学与防护杂志

Objective:To propose a machine learning-based markerless beam′s eye view (BEV) tumor tracking algorithm that can be applied to low-quality megavolt (MV) images with multileaf collimator (MLC)-induced occlusion and non-rigid deformation.Methods:This study processed the registration of MV images using the window template matching method and end-to-end unsupervised network Voxelmorph and verified the accuracy of the tumor tracking algorithm using dynamic chest models. Phantom QA plans were executed after the treatment offset was manually set on the accelerator, and 682 electronic portal imaging device (EPID) images obtained during the treatment were collected as fixed images. Moreover, the digitally reconstructed radiography (DRR) images corresponding to the portal angles in the planning system were collected as floating images for the study of target volume tracking. In addition, 533 pairs of EPID and DRR images of 21 lung tumor patients treated with radiotherapy were collected to conduct the study of tumor tracking and provide quantitative result of changes in tumor locations during the treatment. Image similarity was used for third-party validation of the algorithm.Results:The algorithm could process images with different degrees (10%-80%) of data missing and performed well in non-rigid registration of images with data missing. As shown by the phantom verification, 86.8% and 80% of the tracking errors were less than 3 mm and less than 2 mm, respectively, and the normalized mutual information (NMI) varied from 1.18 ± 0.02 to 1.20 ± 0.02 after registration ( t = -6.78, P = 0.001). The tumor motion of the clinical cases was dominated by translation, with an average displacement of 3.78 mm and a maximum displacement of 7.46 mm. The registration result of the cases showed the presence of non-rigid deformations, and the corresponding NMI varied from 1.21 ± 0.03 before registration to 1.22 ± 0.03 after registration ( t = -2.91, P = 0.001). Conclusions:The tumor tracking algorithm proposed in this study has reliable tracking accuracy and high robustness and can be used for non-invasive and real-time tumor tracking requiring no additional equipment and radiation dose.

Mechanism of Cordycepin Inhibiting Proliferation and Promoting Apoptosis of Hepatoma Cells by Regulating Gli1 / 中国实验方剂学杂志

ObjectiveTo investigate the molecular mechanism of cordycepin inhibiting proliferation and promoting apoptosis of human hepatoma cells （HCCs）. MethodGlioma-associated oncogene homolog 1 （Gli1） gene was silenced by small interfering RNA （siRNA） and transfected into SMMC-7721 cells， and then cell proliferation was detected by cell counting kit-8 （CCK-8） assay and cell cloning assay. SMMC-7721 cells were treated with different concentration of cordycepin， and the cell proliferation and apoptosis were examined. The expression of Gli1 and the downstream related genes was determined by Real-time polymerase chain reaction（PCR） and Western blot. ResultThe mRNA and protein expression of Gli1 in SMMC-7721 cells was higher than that in normal liver cells （P<0.01）. The proliferation rate of SMMC-7721 with silenced Gli1 decreased at 72 and 96 h （P<0.05， P<0.01）， and the colony-forming capacity lowered （P<0.01） compared with those in the blank group. Compared with the control， 80 μmol·L-1 and 120 μmol·L-1 cordycepin significantly inhibited the proliferation of SMMC-7721 cells at 72 and 96 h （P<0.05， P<0.01）， and promoted the apoptosis of them （P<0.01）. Moreover， 80 and 120 μmol·L-1 cordycepin restrained the mRNA and protein expression of Gli1 in SMMC7721 cells （P<0.05， P<0.01）. At 120 μmol·L-1， cordycepin led to the decrease in the mRNA and protein levels of B-cell lymphoma-2 （Bcl-2） and c-Myc （P<0.05， P<0.01）， and the increase in the mRNA and protein expression of cysteine-aspartic acid protease-3 （Caspase-3） （P<0.05）. ConclusionGli1 is highly expressed in HCCs， and cordycepin can suppress the proliferation and enhance the apoptosis of HCCs by regulating Gli1 and the downstream apoptosis-related factors.

A comparison between endoscopic CO2 laser cauterization and open neck surgery in the treatment of congenital piriform fistula / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the efficacy, advantages and disadvantages of endoscopic CO2 laser cauterization (ECLC) and open neck surgery in the treatment of congenital pyriform sinus fistula (CPSF). Methods: From September 2014 to March 2017, 80 cases with confirmed diagnosis of CPSF received initial treatment at Guangdong Provincial People's Hospital were prospectively analyzed, including 34 males and 46 females, aged 18 to 672 (194.17±141.18) months. They were consecutively divided into endoscopic group and open-surgery group, with 40 cases in each group. Both groups of patients received surgical treatment under general anesthesia. The endoscopic group was treated by endoscopic CO2 laser cauterization, and the open-surgery group underwent the following surgery: first, we performed suspension laryngoscopy examination to confirm the presence of fistula in the bottom of the piriform fossa, then open-neck resection of congenital piriform sinus fistula with recurrent laryngeal nerve and/or lateral branch of superior laryngeal nerve anatomy plus partial thyroidectomy were performed. The data between the two groups were compared, including the operative time, intraoperative blood loss, postoperative pain, average length of stay, neck cosmetic scores, complications and cure rates. All patients were followed up in outpatient clinics. Statistical analysis was performed using SPSS 20.0 software. P<0.05 indicates that the difference is statistically significant. Results: All patients were successfully completed the operation. The operative time, intraoperative blood loss, postoperative pain and average length of hospital stay in the endoscopic group were significantly less than those in the open group [(27.4±5.5) min to (105.8±52.5) min, (0.6±0.5) ml to (33.6±41.5) ml, (1.7±0.9) points to (4.6±0.7) points, (5.9±2.9)d to(8.9±3.3)d, t values were-9.400, -5.031, -16.199, -4.293, P values were all<0.01]; The neck cosmetic score in the endoscopy group was significantly greater than that of the open group [(9.9±0.4) against (5.8±0.9) points, t=25.847, P<0.01]. Compared with the open group (15.0%, 6/40), the complication rate of the endoscopic group (7.5%, 3/40) was not statistically significant (χ²=0.50, P>0.05). Three months after the first treatment, the cure rate in the endoscopic group (82.5%, 33/40) was significantly lower than that in the open-neck group (100.0%, 40/40), χ²=5.64, P<0.05. The follow-up time was 12 months after the last treatment. Eighty cases were followed up and none was lost to follow-up. During the follow-up period, the cure rate of the endoscopy group (97.5%, 39/40) was compared with that of the open group (100.0%, 40/40), and the difference was not statistically significant. Conclusions: In the treatment of CPSF, the two-surgical method each has their advantages. Compared with open-neck surgery, ECLC is simpler, repeatable. ECLC has shorter time in operation and hospital stay, less complications, and less postoperative pain and more precise cosmetic results. It could be preferred for the initial treatment of CPSF and relapsed cases after cauterization. But subject to relatively low cure rate of one-time cauterization and uncertain long-term efficacy, it cannot completely replace the open-neck surgery at present.

Effect of transcutaneous electrical acupoint stimulation on venous thrombosis after lung cancer surgery: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on venous thrombosis and quality of life after lung cancer surgery, basing on the conventional nursing and early functional exercise.@*METHODS@#A total of 120 patients diagnosed as non-small cell lung cancer (NSCLC) and received radical resection of lung cancer surgery for the first time were randomized into a conventional nursing group, a rehabilitation training group and a TEAS group, 40 cases in each group. Conventional nursing was adopted in the conventional nursing group. Conventional nursing combined with early functional exercise were adopted in the rehabilitation training group, the exercise was taken 20 min each time, once in both morning and afternoon for 5 days. On the basis of the treatment in the rehabilitation training group, TEAS was applied at Zusanli (ST 36), Xuehai (SP 10), Sanyinjiao (SP 6), etc. in the TEAS group, with disperse-dense wave in frequency of 30 Hz/100 Hz and tolerable intensity, 30 min each time, once in both morning and afternoon for 5 days. The incidence of venous thrombosis in each group was observed at the 5th day after surgery. Before surgery and at the 5th day after surgery, the Caprini thrombus risk assessment was performed, the Karnofsky performance status (KPS) scale and the functional assessment of cancer therapy-lung (FACT-L) were used to evaluate the quality of life.@*RESULTS@#At the 5th day after surgery, no thrombosis was found in the TEAS group, the incidence of venous thrombosis in the TEAS group was lower than 15.0% (6/40) in the conventional nursing group (@*CONCLUSION@#On the basis of the conventional nursing and early functional exercise, TEAS can reduce the incidence of venous thrombosis, effectively prevent thrombosis and improve quality of life.

Effect of gonadotropin releasing hormone agonist combined with different add-back therapy and its influence on the related serological indexes after the operation of maintaining fertility function of endometriosis / 中国综合临床

Objective:To analyze the application and serological effect of add-back drugs during gonadotropin releasing hormone agonist (GnRH-a) administration for patients with endometriosis after laparoscopic treatment.Methods:From May 2016 to July 2018, the clinical data of 108 patients with stage III and IV endometriosis diagnosed in Nanjing Hospital Affiliated to Nanjing Medical University were analyzed by retrospective case-control study.According to different intervention methods, they were divided into three groups (gonadal hormone releasing hormone agonist group, gonadal hormone releasing hormone agonist + estradiol valerate group, gonadal hormone releasing hormone agonist + tibolone group), 36 cases in each group.All the patients in the three groups received laparoscopic fertility preserving surgery.After the operation, the gonadal hormone releasing hormone agonist group was treated with gonadal hormone releasing hormone agonist, the gonadal hormone releasing hormone agonist + estradiol valerate group was treated with gonadal hormone releasing hormone agonist and estradiol valerate, the gonadal hormone releasing hormone agonist + tibolone group was treated with gonadal hormone releasing hormone agonist and tibolone.The visual analog scale (VAS), modified Kupperman score, follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, tumor necrosis factor (TNF)-α, interleukin (IL)-6 were evaluated and compared among the three groups.Results:Before treatment, the VAS scores of the three groups were (6.77±2.15), (6.86±1.97), (6.73±2.06), the modified Kupperman scores were (8.15±1.36), (8.22±1.29), (8.19±1.31), the FSH scores were (5.22±1.21), (5.18±1.19), (5.26±1.23) U/L, the LH scores were (6.89±1.64), (7.12±1.57) U/L, and the estradiol scores were (152.64±23.57), (161.65±20.48), (158.49±19.37) pmol/L.TNF-α were (41.25±6.49), (38.62±7.41), (38.18±7.35) mg/L, IL-6 were (127.64±16.35), (126.73±15.84), and (128.23±15.91) ng/L, respectively.After treatment, VAS scores were (1.71±0.63), (1.82±0.59), (1.74±0.55), modified Kupperman scores were (17.33±3.67), (12.41±3.35), (14.45±3.18), FSH scores were (1.62±0.39), (1.74±0.43), (1.78±0.45) U/L, LH were (1.96±0.59), (2.11±0.48), (2.07±0.52) U/L, estradiol were (36.42±7.51), (53.62±10.44), (51.27±9.69) pmol/L, TNF-α were (13.36±3.17), (12.45±2.96), (12.62±3.04) mg/L, IL-6 were (22.42±4.18), (23.79±3.17), (23.21±3.05) ng/L, respectively.After treatment, only the modified Kupperman score was significantly higher than that before treatment ( t=14.07, 7.00, 10.92, all P<0.001); others were significantly lower than that before treatment (VAS score: t=13.55, 14.70, 14.04, all P<0.001; FSH: t=16.99, 16.31, 15.94, all P<0.001; LH: t=16.97, 18.31, 17.63, all P<0.001; estradiol: t=28.19, 28.20, 29.70, all P<0.001). After treatment, the modified Kupperman scores of GnRH agonist+ estradiol valerate group and GnRH agonist+ tibolone group were significantly lower than those of GnRH agonist group (all P<0.05). The levels of estrogen in gonadal hormone releasing hormone agonist+ estradiol valerate group and gonadal hormone releasing hormone agonist+ tibolone group were significantly higher than those in gonadal hormone releasing hormone agonist group (all P<0.05). The incidence of hot night sweat was 5.56% (2/36) in gonadal hormone releasing hormone agonist+ estradiol valerate group and 8.33% (3/36) in gonadal hormone releasing hormone agonist+ tibolone group, significantly lower than 66.67% (24/36) in gonadal hormone releasing hormone agonist group (χ 2=43.653, P<0.001). Conclusion:Postoperative GnRH-a combined with estradiol valeate or tibolone can significantly improve the clinical efficacy, sexual hormone level and inflammatory response of patients with endometriosis, and has a certain safety.

Analysis of micro-lecture demands on the teaching of physical diagnosis in Clinical Skills / 中华医学教育探索杂志

Objective@#To further improve the proficiency and accuracy of physical diagnosis of medical students.@*Methods@#On March 16th, 2018, a random questionnaire survey were conducted and Excel used to investigate and analyze the needs of junior medical students for the teaching of physical diagnosis from the perspectives of topic selection of micro-lecture, presentation, teaching hours etc..@*Results@#A total of 174 questionnaires were distributed and were all took back. In the survey, 139 students (79.89%) hoped to apply micro-lecture to the teaching of physical diagnosis, 132 students (75.86%) thought that the proper time of micro-lecture for each physical examination item should be 2-5 minutes, 150 students (86.21%) expected to learn micro-lecture of physical diagnosis via WeChat. Physical examination items selected mostly by students were on heart, chest and nervous system.@*Conclusion@#Theoretically and technologically speaking, it is feasible to make micro-lecture of physical diagnosis. Therefore, we should actively carry out the micro-lecture of physical diagnosis to meet students' learning demands and improve their operation skills of physical diagnosis.

Effects of Lianggesan on serum citrulline and intestinal fatty acid binding protein levels in patients with mechanical ventilation and gastrointestinal injury / 中国中西医结合急救杂志

Objective To observe the effects of Lianggesan on serum citrulline and intestinal fatty acid binding protein (IFABP) levels in patients with mechanical ventilation and acute gastrointestinal injury (AGI). Methods Eighty patients with mechanical ventilation and AGI admitted to Tianjin First Center Hospital from May to December 2017 were divided into a conventional treatment group and a traditional Chinese medicine (TCM) treatment group according to different treatment methods, 40 cases in each group; 10 patients with mechanical ventilation but without AGI were selected as a control group. All patients were given invasive mechanical ventilation after admission, and the gastrointestinal tract intervention was carried out according to AGI grading treatment process; Lianggesan (compositions:forsythia suspensa 30 g, scutellaria 10 g, gardenia 10 g, bamboo leaf 10 g, rhubarb 10 g, mint 6 g, mirabilite 6 g, licorice 15 g) was added to the TCM treatment group on the basis of the conventional treatment. The above TCM drug used was a single Chinese medicine granule produced by Jiangyin Tianjiang Pharmaceutical Co., Ltd. Each single Chinese herbal granule was proportionally poured into 200 mL boiling water at 80-100 ℃, 100 mL each time, twice daily nasal feeding for one week. The changes of serum citrulline and IFABP levels were observed before and 1, 3, 5 and 7 days after treatment in the three groups. Results Before treatment, serum citrulline levels in the conventional treatment group and the TCM treatment group were significantly lower than those in the control group (μmol/L: 19.84±4.74, 20.84±4.65 vs. 28.89±2.18, both P < 0.05), and IFABP levels were significantly higher than those in the control group (ng/L:571.89±42.89, 552.49±44.78 vs. 155.68±22.95, both P < 0.05), there were no significant differences between the conventional treatment group and the TCM treatment group (P > 0.05); with the extension of treatment time, the levels of citrulline in the conventional and TCM treatment groups were decreased first and then increased gradually, reaching the valley value on the first day of treatment [the two groups were (16.12±4.44), (18.49±4.59) μmol/L] respectively, and then increased gradually, reaching the peak value on the 7th day of treatment, the increased range of citrulline in the TCM treatment group was more obvious than that in the conventional treatment group (μmol/L: 26.77±4.18 vs. 22.75±3.07, P < 0.05), and the treatment lasted for 5 days, and 7 days, the level of citrulline in the TCM treatment group was close to that in the control group; the IFABP levels in the conventional treatment group and the TCM treatment group were increased first and then decreased gradually, reaching the peak value on the first day of treatment [the two groups were (654.23±63.24), (630.32±49.11) ng/L] respectively, and then decreased gradually, reaching the trough value on the 7th day of treatment, the degree of decrease in the TCM treatment group was more obvious than that in the conventional treatment group (ng/L: 262.21±30.89 vs. 375.43±44.43, P < 0.05), but the level of IFABP in the TCM treatment group was still significantly higher than that in the control group (ng/L: 262.21±30.89 vs. 158.95±29.34, P < 0.05). Conclusion Lianggesan can elevate the serum citrulline level, reduce the serum IFABP level, and effectively improve the intestinal function of patients with mechanical ventilation and AGI.

The early diagnostic value of IAP combined with IFABP for patients with mechanical ventilation complicated with AGI / 中华急诊医学杂志

Objective To investigate the early diagnostic value of intra-abdominal pressure (IAP) combined with intestinal fatty acid binding protein (IFABP) for patients with mechanical ventilation complicated with acute gastrointestinal injury (AGI).Methods From August 2015 to December 2015,1 19 patients with mechanical ventilation were admitted to ICU in our hospital,with 78 cases of AGI patients and 41 cases of non-AGI patients.Multiple physiological indexes and laboratory indexes of the two groups were recorded and compared.Results There was no statistical difference in sex,age,APACHE Ⅱ score,BMI index,Lac and mean arterial pressure (MAP) between the two groups (P ＞0.05);the OR values of mechanical ventilation time,oxygenation index,end-expiratory positive pressure (PEEP),CIT,IFABP and IAP were more than 1,so these indicators were all risk factors for AGI in patients with mechanical ventilation.The area under the curve of IAP,IFABP,mechanical ventilation and PEEP were more than 0.5,indicating that these indicators have a certain predictive value for AGI patients with mechanical ventilation.The sensitivity and specificity of IAP were 95％ and 80％ respectively,and the sensitivity and specificity of IFABP were 87.5％ and 50％,respectively.IAP was correlated with IFABP (r =0.621,P =0.031).Conclusions Mechanical ventilation time,oxygenation index,PEEP,CIT,IFABP,and IAP are risk factors for AGI patients with mechanical ventilation.IAP,IFABP,mechanical ventilation time and PEEP have a certain predictive value for AGI patients with mechanical ventilation.The diagnostic value of IAP and IFABP is high,and the two are closely related.Combined application can provide a certain objective basis for clinical AGI diagnosis.

Analysis of micro-lecture demands on the teaching of physical diagnosis in Clinical Skills / 中华医学教育探索杂志

Objective To further improve the proficiency and accuracy of physical diagnosis of medical students. Methods On March 16th, 2018, a random questionnaire survey were conducted and Excel used to investigate and analyze the needs of junior medical students for the teaching of physical diagnosis from the perspectives of topic selection of micro-lecture, presentation, teaching hours etc.. Results A total of 174 questionnaires were distributed and were all took back. In the survey, 139 students (79.89％) hoped to apply micro-lecture to the teaching of physical diagnosis, 132 students (75.86％) thought that the proper time of micro-lecture for each physical examination item should be 2-5 minutes , 150 students (86.21％) expected to learn micro-lecture of physical diagnosis via WeChat. Physical examination items selected mostly by students were on heart , chest and nervous system . Conclusion Theoretically and technologically speaking, it is feasible to make micro-lecture of physical diagnosis. Therefore, we should actively carry out the micro-lecture of physical diagnosis to meet students' learning demands and improve their operation skills of physical diagnosis.

Application of Quality Control Circle in Shortening Drug Dispensing Time in the Inpatient Pharmacy of Our Hospital / 中国药房

OBJECTIVE: To shorten drug dispensing time of inpatient pharmacy in our hospital, and to enhance the quality of pharmaceutical care.METHODS: The activity of quality control circle (QCC) was carried out by using "shorten drug dispensing time of inpatient pharmacy" as subject. According to the steps of QCC activity, key links and factors that influence the of drug dispensing time in the inpatient pharmacy were found out. Countermeasures were formulated and implemented according to practical reasons. The activity was evaluated by using the drug dispensing time in every 100 medical orders before and after QCC activity. RESULTS: According to the links of "dispensing medical order" and "checking medical order" that spent longest time, the countermeasures were put forward to improve work efficiency, such as rational drug distribution and design, opmitization of the dispensing route, realizing electronic large infusion prescription by strengthening system informatization, strengthening the management of confusing drugs, strengthening staff training and establishing performance appraisal system. The drug dispensing time was shortened from 43. 99 min (before QCC) to 21. 77 min (after QCC), and target achievement rate was 99. 24％. QCC staff showed positive growth in means, responsibility, team cohesion and other aspects. CONCLUSIONS: QCC activity can shorten the time of drug dispensing, improve work efficiency and pharmacist' s ability of solving problem, and help to improve pharmaceutical care in the inpatient pharmacy.

Study on Chemical Compounds and in vitro Antibacterial and Antioxidant Activities of Monoraphidium dy-bowskii / 中国药房

OBJECTIVE:To study chemical compounds of Monoraphidium dybowskii,and to investigate the in vitro antibacte-rial and antioxidant activities of isolated compounds. METHODS:The ethanol extract of M. dybowskii were extracted with aether petrolei,ethyl acetate and n-butyl alcohol. The ethyl acetate extract was separated from M. dybowskii and chemical components were analyzed by sillica gel column chromatogram,HPLC and GC-MS. Their structures were identified according to physicochemi-cal properties and NMR. MIC of 4 isolated compounds to Pseudomonas aeruginosa,Candida albicans,Bacillus subtilis and Esche-richia coli were determined by resazurin disc test. Free radical scavenging rate(concluated by IC50)and reducing capacity were mea-sured by 1,1-diphenyl-2-picryl-diazanyl (DPPH) and ferric reducing antioxidant power (FRAP) assay. RESULTS:Compounds 1-6 were obtained from E4 and E5 segments of ethyl acetate extract of M. dybowskii,and their structures were identified as stigmas-terol,diisonoyladipate,indole-3-carboxylic acid,(+)-epiloliolide,(-)-loliolide,5-hydroxy-3,4-dimethy-5-pentyl-2(5H)-furanone. MIC of compounds 3-6 were 10-500 μg/mL,and IC50 ranged 22.02-71.01 μg/mL;FRAP ranged (62.04 ± 5.36)-(281.22 ± 8.3) μmol/L. CONCLUSIONS:M. dybowskii contains multiple lipid and alkanoic acid,and possesses certain in vitro antibacterial and antioxidant activities.

Analysis of the efficacy of pirarubicin combined with paclitaxel in the treatment of three negative breast cancer / 中国生化药物杂志

Objective To study the clinical efficacy of epirubicin combined with paclitaxel in the treatment of three negative breast cancer.Methods 100 patients with breast cancer who were treated in Shanxi Cancer Hospital from January 2014 to December 2016 were selected as the research object in this study.They were randomly divided into the control group and the experimental group, with each group having a total of 50 patients.The control group was treated with epirubicin, and the experimental group was treated with epirubicin combined with paclitaxel.The short-term remission rate, Karnofsky score and the incidence of adverse symptoms were compared between the experimental group and the control group.Results After treatment, the Karnofsky score of the experimental group was(89.76±10.12), and the Karnofsky score of the control group was(71.23±11.67).The Karnofsky score of the experimental group was significantly higher than that of the control group (P<0.05).In the experimental group, the number of short-term remission was 44 cases, the short-term remission rate was 88.0%, and the number of patients in the control group in the recent remission was in the number of cases, the short-term remission rate was 72.0%, and the number of patients in the control group was about 36.The results showed that the short-term remission rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).After treatment, there was no significant difference between the control group and the experimental group in the incidence of complications, which was not statistically significant.Conclusion The clinical effect of doxorubicin plus paclitaxel in the treatment of three negative breast cancer, can improve the remission rate in a large extent, improve the quality of life of patients, with further clinical promotion and application significance.

Studies on chemical compounds of Chlorella sorokiniana / 中国中药杂志

Chemical constituents of Chlorella sorokiniana were isolated and purified by repeated column chromatographies, over silicagel and Sephadex LH-20. Their structures were identified on the basis of physicochemical properties and spectroscopic data analysis. Five compounds were obtained from the petroleum ether extract of Chlorella sorokiniana, and their structures were identified as (22E, 24R)-5alpha, 3beta-epidioxiergosta-6, 22-dien-3beta-ol(1),(24S)-ergosta-7-en-3beta-ol(2), loliolide(3), stigmasta-7,22-dien-3beta,5alpha,6alpha-triol(4), and 3beta-hydroxy-5alpha,6alpha-epoxy-7-megastigmen-9-one(5). The main liposoluble fractions from Chlorella sorokiniana maiuly contain fatty acids, alkyl acids and olefine acids. Components 1-5 were isolated from the genus Chlorella for the first time.

Clinical approach to the neuroischemic ulcers in diabetic foot / 中华内分泌代谢杂志

[Summary] Neuroischemic diabetic foot ulcer ( NDFU) is characterized by infection, ulceration of deep tissues, neurological abnormalities, and various degrees of peripheral vascular disease in the lower limbs. The patients often have multiple risk factors such as older, longer duration, cardiovascular disease. The treatment is very difficult. The prognosis depends on the severity of complications, tissue range of infections, and the peripheral vascular disease. In this article, the treatment process of an old inpatient with NDFU and severe complications was reviewed and to propose a standard pathway for its management.

Effectiveness and safety of sodium glycididazole for nasopharyngeal carcinoma radiotherapy:a Meta-analysis / 国际肿瘤学杂志

Objective To assess the efficacy and safety of radiotherapy combined with sodium glyci-didazole (CMNa)in treating nasopharyngeal carcinoma by conducting a Meta-analysis.Methods Randomized clinical controlled studies (RCTs)of radiotherapy plus CMNa versus radiotherapy alone in the treatment of nasopharyngeal carcinoma were retrieved from China Biology Medicine disc,China National Knowledge Infrastruc-ture,digital journal of Wanfang Data,China Science and Technology Journal Database,PubMed and Cochrane Library.According to the inclusion and exclusion criteria,data extraction and quality assessment were done by two researchers independently,and clinically important measures were selected.Outcomes were pooled with Rev-Man 5.2.Results The rate of complete remission (CR)in the radiotherapy combined CMNa group was better than that in the radiotherapy alone group in 1 .41 multiple to primary lesion,RR =1 .41 ,95%CI:1 .30-1 .52, Z =8.20,P =0.00.To lymphonodi cervicales metastasis,the rate of CR in the radiotherapy combined CMNa group was better than that in the radiotherapy alone group in 1 .45 multiple,RR =1 .45,95%CI:1 .30-1 .62, Z =6.50,P =0.00.There were no significant differences in the incidence rates of adverse reactions of skin (RR =0.97,95%CI:0.87-1 .08,Z =0.57,P =0.57 ),mucosa (RR =1 .03,95%CI:0.93-1 .15,Z =0.65, P =0.52 )and decrease in white blood cells (RR =0.84,95% CI:0.56-1 .25,Z =0.87,P =0.38). Conclusion In the treatments of nasopharyngeal carcinoma,the rates of CR of primary lesion and lymphonodi cervicales metastasis in radiotherapy combined with CMNa group are superior to the radiotherapy alone group. However,the occurrence rates of adverse reactions in the two groups have no obvious differences.

Kirschner wire as blocking screws for the treatment of tibial metaphyseal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical outcomes of Kirschner wire as blocking screws combined with interlocking intramedullary nail internal fixation in treating tibial metaphyseal fractures (AO 43A).</p><p><b>METHODS</b>From March 2011 to June 2012, 9 patients with tibial metaphyseal fractures were treated with blocking screws Kirschner wire combined with interlocking intramedullary nail, including 7 males and 2 females aged from 23 to 54 years old with an average of 37.4. Postoperative complications, X-ray were observed, AOFAS scoring were used to evaluate function after operation at 12 weeks.</p><p><b>RESULTS</b>All patients were followed up from 6 to 40 weeks (mean 20.1), and healed at stage I. No serious swelling, infection and skin necrosis occurred. No fracture instability and displacement appeaered at 4 and 8 week after operation. AOFAS score was (95.2±4.6) at 12 weeks after operation and 7 patients gained excellent result and 2 patients good.</p><p><b>CONCLUSION</b>Kirschner wire as blocking screws with interlocking intramedullary nail for treatment of tibial metaphyseal fractures can fix well and perform simply.</p>

Applications and prospect of multiple displacement amplification in preimplantation genetic diagnosis / 中华医学遗传学杂志

Multiple displacement amplification (MDA) is a new technology for whole genome amplification (WGA), which can generate large amount of high-quality DNA and features high amplification efficiency and fidelity. MDA combined with conventional PCR techniques has been successfully applied for preimplantation genetic diagnosis, which has broaden latter's clinical applications.